Horner's syndrome after lumbar epidural analgesia during labor

Horner's syndrome is rarely reported after epidural analgesia during labor. The use of Top-Up local anesthetic for controlling labor pain in the first stage of labor, or to dense the block in caesarean deliveries can result in this complication. We reported a cases of Horner's syndrome during epidural analgesia in labor in spite of not giving any Top-Up dose. The case was clinically evident and was successfully managed by stopping the epidural infusion, and reassuring the parturient as well as the family; until the disappearance of the signs and symptoms. The infusion was then restarted, delivery was uneventful and no consequent neurological or psychological problems were noticed after a one-month follow-up

Intravenous dexmedetomidine prolongs bupivacaine spinal analgesia

The prolongation of spinal anesthesia by using clonidine through the oral, intravenous and spinal route has been known. The new ?2 agonist, dexmedetomidine has been proved to prolong the spinal anesthesia through the intrathecal route. We hypothesized that dexmedetomidine when administered intravenously following spinal block, also prolongs spinal analgesia. 48 patients were randomly allocated into two equal groups following receiving spinal isobaric bupivacaine 12.5 mg. Patients in group D received intravenously a loading dose of 1 microg/kg dexmedetomidine over 10 min and a maintenance dose of 0.5 microg/kg/hr. Patients in group C [the control group] received normal saline. The regression times to reach S1 sensory level and Bromage 0 motor scale, hemodynamic changes and the level of sedation were recorded. The duration of sensory block was longer in intravenous dexmedetomidine group compared with control group [261.5 +/- 34.8 min versus 165.2 +/- 31.5 min, P < 0.05]. The duration of motor block was longer in dexmedetomidine group than control group [199 +/- 42.8 min versus 138.4 +/- 31.3 min, P < 0.05]. Intravenous dexmedetomidine administration prolonged the sensory and motor blocks of bupivacaine spinal analgesia with good sedation effect and hemodynamic stability

Duration of venous occlusion with lidocaine for preventing propofol induced pain

To study the effect of the venous occlusion duration using lidocaine on the incidence and severity of propofol induced pain. A prospective double-blind randomized study was designed at Jordan University Hospital, Amman, Jordan between October 2007 and November 2007. One hundred and fifty patients aged 14-70 years, American Society of Anesthesiologists [ASA] clinical status I and II who underwent elective surgeries under general anesthesia, were divided into 3 groups. All 3 groups had propofol 1% infusion at a constant rate after applying venous occlusion with lidocaine. The occlusion was applied for 15 seconds [group I, n=50], 30 seconds [group II, n=50] and 60 seconds [group III, n=50]. Pain was assessed during injection according to a verbal pain score. Fourteen patients 28% had pain in group I, compared to 16 patients 32% in group II, and 9 patients 18% in group III. This difference did not reach statistical significance p>0.05 for the incidence and severity of pain. While venous occlusion with lidocaine is an effective method in relieving propofol induced pain, we found no difference when the duration of venous occlusion was 15, 30, or 60 seconds

Rapid sequence induction and intubation with 1 mg/kg rocuronium bromide in cesarean section, comparison with suxamethonium

To demonstrate that Rocuronium Bromide can be used for rapid sequence induction in emergency conditions. Our study was performed between December 2005 and May 2006 in Jordan University Hospital, Jordan. We studied the efficacy and intubating conditions after administrating of Rocuronium Bromide 1 mg/kg at 60 second in group of 60 pregnant women undergoing elective or emergency cesarean section and compared the results with those obtained after giving Suxamethonium 1 mg/kg at 60 seconds in a group of patients similar to the Rocuronium group. Intubating conditions after 1 mg /kg of Rocuronium Bromide were found to be acceptable [good and excellent] in 95% of patients and were similar to the Suxamethonium group [97%]. The endotracheal tube could be passed through the vocal cards of all patients enrolled in the study. Rocuronium Bromide 1 mg/kg can be safely used for rapid sequence induction in cesarean section and the intubating conditions are similar to those of Suxamethonium

Venous occlusion with lidocaine for preventing propofol induced pain. A prospective double-blind randomized study

Pain is a well-known complication of intravenous administration of propofol, and to find out the optimal method to decrease this pain, we studied 4 methods of delivering propofol. The study took place at Jordan University Hospital, Amman, Jordan between November 2004 and March 2005 on 200 patients. The patients were divided into 4 groups, group I [n=50], the control group, propofol 1% was given alone. Group II [n=50], patients received propofol 1% premixed with 40 mg of lidocaine. Group III [n=50], patients received propofol 1% 60 seconds after giving 40 mg of lidocaine. Group IV [n=50], patients had venous occlusion for 60 seconds with the use of lidocaine 1% [40 mg], followed by release of the occlusion and administration of the propofol. Pain was assessed during injection and categorized into: no pain, pain, and pain with behavioral changes. In group I [control], 35 patient complained of pain, compared to 26 in group II, 23 in group III, and 7 patients in group IV, with a significant reduction in the incidence and intensity of pain in group II, III, and IV compared with the control [p<0.005]. The best reduction of intensity and incidence was achieved in group VI, when compared with groups I, II and III [p<0.005], with no statistical difference between group II and III when compared with each other. Of the 4 methods studied, the optimal method to decrease the incidence and intensity of pain resulting from propofol injection is to inject lidocaine while applying venous occlusion for 60 seconds prior to administering propofol